Breast cancer takes away women’s choices. Many women decide to regain control of their bodies and prevent future cancer or follow-up surgeries by having a double mastectomy without any reconstruction, leaving a fat chest. When their doctors refuse to perform this surgery or their insurers refuse to cover this form of chest reconstruction, women are traumatized by their loss of choice in a system that clings to the outdated idea that women cannot be feminine without breasts. The Women’s Health and Cancer Rights Act of 1998 was intended to protect women facing cancer from the second trauma of being unable to afford their breast reconstruction. New York has passed legislation making it explicit that fat chest reconstruction is breast reconstruction and must be covered. Other states should follow suit, especially in the face of the surge in anti-trans legislation banning gender-affrming surgeries for trans men, which could further limit women’s options by banning the surgical creation of flat chests for cancer patients. In the absence of such state legislative action, insurers and courts should read the Women’s Health and Cancer Rights Act to include reconstruction of both protruding breasts and fat chests in order to make women whole again after cancer.

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